Mortality prediction by hormonal profile versus APACHE score assessment in critically ill patients

Objectives

To investigate hormonal changes during the acute phase of critical illness, to analyze their relationship to severity, and to evaluate their discriminating ability on critically ill patients' outcome.

Design

A prospective cohort study of patients requiring intensive care.

Setting

Adult medical, surgical and coronary care units in Mansoura University Emergency Hospital.

Patients

A total of 40 consecutive patients requiring intensive care over a 5-month period and 10 healthy subjects of matched age and sex were selected as references control subjects.

Interventions

For each patient included in our study the following was done. First, APACHE III score. Second, blood samples were taken in three occasions, on admission, third and seventh days of admission to the ICU. The plasma was separated and kept at -80°C until time of analysis. The following hormones (cortisol, growth hormone, thyroxin, and triiodothyronine hormones) were determined by ELISA technique.

Measurements and main results

The best discriminators of patient outcome in descending order were the serum basal cortisol, then APACHE III score, then thyroxine hormone, then triiodothyronine on day 1 of admission with odd ratios of 11, 8.5, 3.2 and 2.85, respectively.

Conclusion

Certain endocrinal parameters, mainly basal serum cortisol level obtained during ICU admission, might be simple, cheap and superior discriminators of patient outcome than the APACHE III score.